The significance of productivity resonates not only within clinical realms but also extends to non-clinical services. Meridian’s strategic focus in these areas revolves around precise forecasting, strategic planning, and optimal allocation of tasks to the most apt individuals.
Within the Portering domain, the synchronisation of capacity and demand, coupled with a nuanced comprehension of workflow equilibrium, emerges as pivotal. This service plays an indispensable role in ensuring the seamless functioning of numerous clinical departments, thus meriting a commensurate level of attention.
Similarly, Catering stands as another sphere where the roots of productivity prominently surface. From the thoughtful design of menus to meticulous portion control, substantial improvements have been realised within Catering services. These enhancements translate into reduced cost per portion while concurrently upholding unwavering standards of quality—maintained every hour, every day.
Case Studies: Portering, Catering & Non-clinical services
The study focused on identifying the potential to increase the amount of reporting done within scheduled reporting sessions and the potential to improve the utilisation of the scanning resources, reducing the operating costs.
The project was designed to increase the amount of time spent clinically with patients whilst increasing the quality of service provided to all users, and to make financial cost improvements for efficiency purposes.
The programme covered the operations of the finance department and focused on identifying and agreeing what constituted ‘core’ and ‘non-core’ activities, installing role-specific management expectations and developing tools to track against KPIs.
Historically, there had never been a link between the demand on each team and the resource provided. Meridian conducted an analysis to identify, evidence and implement control of the required level of resource to service each localities patient needs.
The analysis identified that discharge dates were not routinely set or known by clinicians in the care pathway. ‘Out of trust’ bed night usage of 31 beds per night on average and variances within the Trust’s control were causing delays to discharge.
The Meridian study identified opportunities within the Working Age Adult and Older Adult Community teams to improve productivity and reduce the average length of stay on the Older Adult inpatient wards.
National guidelines specify 25 hours/week of meaningful activity provided to forensic patients. The management controls did not allow to quantify the activity each patient received and did not track the amount of activity delivered by the MDTs.
The analysis identified a number of key management procedures, either under-utilised or not in place. As a result, the current system showed a lack of control over activity, expectation, and performance.
The system within Community MH Teams and Inpatient MH Wards showed a lack of control over activity, expectation, and performance, resulting in only 21% direct clinical contact in the community and significant lengths of stay.
The clinic utilisation, across all observed disciplines was 49% against a national expectation of 85%. There was a high proportion of missing medical records, and out of all observed patients only 15% were seen at their appointed time.
There was a laisse-faire attitude to late starts of 44% and late finishes of 31% with no quantification of the effect on staff rostering, the accumulated time off in lieu and clinic session utilisation of only 77% whilst the Trust was also running waiting list initiatives.
The study found opportunities to standardise and fix therapists’ clinic templates, increase visibility of the referral waiting lists at all points in the patient flow and develop management control on capacity and demand across the teams.
The service suffered from a lack of performance data, clear targets and expectations, planning standards and a systematic and robust way of allocating work ensuring clinic maximisation as well as an effective follow up process.
Meridian undertook an analysis of sessional fulfilment, and planned verses actual activity levels of clinics, incorporating quantification of the volume of extra Waiting List Initiatives (WLIs) that had been carried out, with a view to repatriate waiting WLIs into core sessions.
Action had been taken to cease additional spend on ‘extra’ outpatient capacity, but there was no system to assess the impact. Similarly, there was no means to quantify or review the utilisation of the resources or clinic slots and sessions.
The system and processes in place showed a general lack of control over the inputs and outputs of theatre and an inability to effectively control the available resources, with the result that the service was not achieving its potential in terms of throughput and value for money.
The organisation had installed various initiatives around its Operating Theatres, but was still struggling to align its capacity with its demand. Many specialties were not fulfilling their contracted levels of activity and as such the Trust was operating with a significant financial deficit.
In the previous financial year, the Endoscopy Department under-delivered on their contracted activity, and waiting list initiatives were used to deal with follow up demand. The current system showed a lack of control over activity, expectation, and performance and therefore an opportunity presented itself to the Trust.
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